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General NPI Number Information
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NPI Number | 1730563909
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Entity Type | Organization
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Legal Business Name | RADIAL FIRST CARDIOVASCULAR ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE SUITE 3
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6371
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Country | US
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Telephone | 208-523-3050
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Fax | 208-523-4985
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Provider Business Mailing Address
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Address Line | 2001 S WOODRUFF AVE SUITE 3
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6371
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Country | US
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Telephone | 208-523-3050
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Fax | 208-523-4985
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN E LASSETTER
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Credential | M.D.
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Telephone | 480-318-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | M11673
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License Number State | ID
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